DERMATOMYOSITIS-LIKE ADVERSE CUTANEOUS RE ACTIONS SECONDARY TO LONG-TERM HYDROXYUREA THERAPY

We report on dermatomyositis-like adverse cutaneous reactions followin g long-term maintenance therapy with hydroxyurea in two patients suffe ring from chronic myelogenous leukaemia (CML). In addition to non-spec ific side effects, such as xerosis, pruritus and hyperpigmentation, bo th patients presented with more specific skin changes, i.e. erythemato us lesions, scaling, and partially atrophic areas distributed in a lin ear fashion on the dorsal aspects of the hands and fingers. In additio n, teleangiectatic erythema of the face was present in both patients, and this was associated with oedema of the eyelids in one patient. Des pite these dermatomyositis-like features there were no clinical signs of muscular involvement, and muscle-specific enzymes were within norma l ranges. Skin biopsy specimens revealed an interface dermatitis chara cterized by a lichenoid cell infiltrate, vacuolar alteration of basal cells, necrotic keratinocytes within the spinous 2one, focal hypergran ulosis, orthohyperkeratosis and telangiectases in the upper part of th e dermis. Analogous histopathological findings have been documented in lichen planus-like skin changes on the hands following hydroxyurea th erapy. It seems doubtful whether there are actually any major differen ces between those skin changes described as dermatomyositis-like and t hose interpreted as lichen planus-like in patients receiving long-term hydroxyurea therapy.